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  1. Variations in patient management and outcomes for acute myocardial infarction in the United States and other countries : results from the GUSTO trial.

    Article - En anglais

    Objective

    - To examine differences in outcomes and patient management between patients in the United States and outside the United States undergoing thrombolysis for acute myocardial infarction.

    Design, Setting, and Patients

    - Patients in the United States (n=23 105) and 14 other countries (n=17 916) were randomized to receive streptokinase plus either subcutaneous or intravenous (IV) heparin, accelerated recombinant tissue-type plasminogen activator (rt-PA) plus IV heparin, or combined streptokinase and rt-PA plus IV heparin.

    Results

    - Mortality reduction with accelerated rt-PA vs streptokinase was greater in the United States (1.2% absolute decrease vs 0.7% elsewhere), but the test for treatment-by-country interaction against streptokinase was not significant (P=30).

    Benefits of accelerated rt-PA over combination therapy were observed in the United States, but not in other countries (P=02).

    Despite differences in baseline characteristics and patient management, 30-day mortality was not significantly different : 6.8% in the United States vs 7.2% elsewhere (P=09).

    Conclusions

    - No significant evidence for a differentially greater benefit of accelerated rt-PA over streptokinase was found in US vs non-US patients.

    However, increased procedure and treatment use in the United States was associated with only a small decrease in short-term mortality.

    Long-term.

    Mots-clés Pascal : Infarctus, Myocarde, Protocole thérapeutique, Efficacité traitement, Evolution, Monde Ouest, Amérique du Nord, Etude comparative, Traitement, Survie, Epidémiologie, Homme, Amérique, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie

    Mots-clés Pascal anglais : Infarct, Myocardium, Therapeutic protocol, Treatment efficiency, Evolution, Western countries, North America, Comparative study, Treatment, Survival, Epidemiology, Human, America, Cardiovascular disease, Coronary heart disease, Myocardial disease

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 95-0364797

    Code Inist : 002B30A01C. Création : 01/03/1996.